Junk medical claims about vitamins are shouted from the rooftops of the internet, over and over. I can barely keep up with it. The claims about vitamin D seem to be trendy now. That means it’s time for vitamin D review – is it worth it, or is it a waste of your money?
Now, I don’t think vitamin D is worthless. It is an important micronutrient for human health, and if there’s a chronic deficiency, supplementation is necessary.
Proponents of megadoses of vitamins, called megavitamin therapy or orthomolecular medicine (pseudoscientific terms to sound like they are based on real science), seems to work on the unscientific belief that if a little helps, a whole boatload will help a lot more. Most of these ideas have been debunked and are considered quackery and fads.
I wanted to take a look at vitamin D, from it’s actual benefits to health to the possible dangers from supplementation.
What is vitamin D
Vitamin D is a group of fat-soluble secosteroids (it’s a scientific name for a steroid with a “broken” ring). The most important chemicals in this group are vitamins D3 (known as cholecalciferol) and D2 (known as ergocalciferol).
Very few foods contain either of the important types of vitamin D. However, the following foods can be good sources for the vitamin:
- Fatty fish, like tuna, mackerel, and salmon
- Foods fortified with vitamin D, like some dairy products, orange juice, soy milk, and cereals
- Beef liver
- Egg yolks
Many people with broad diets that include a lot of fish, eggs, and other foods can get sufficient vitamin D without supplementation. As I’ve repeated often, short of chronic malnutrition, we get plenty of vitamin D.
But even then, vitamin D is produced by a process called dermal synthesis. That is, sunlight, specifically UV-B radiation, causes synthesis of vitamin D in the skin. Technically, vitamin D isn’t a vitamin, because we can manufacture it, it is really a hormone. For this article, we’ll just call it a vitamin. But it’s not.
Even though we can manufacture sufficient vitamin D by sunbathing every day, the body has a feedback loop that shuts down production to prevent toxicity. Yes, excess vitamin D is quite dangerous leading to many conditions such as over absorption of calcium to hypertension to fatigue. But it also can lead to some dangerous chronic conditions that we’ll discuss later.
Although humans can manufacture vitamin D by sitting in bright sun, there’s one major problem – risk of skin cancer. As I’ve written before, there are very few ways to actually prevent cancer, but staying out of the sun is one of them.
Finally, the vitamin D we consume or produce in sunlight is not biologically active. It is generally activated by enzymatic conversion (in a process called hydroxylation) in the kidneys and liver so that the body can use it.
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What does vitamin D do or don’t do?
Based on real scientific evidence, vitamin D has a very narrow, but important, set of effects.
First, it is responsible for enhancing intestinal absorption of calcium, iron, magnesium, phosphate, and zinc, important minerals for continued health of any human being. Many of these minerals (and vitamin D itself) is necessary for good bone health.
Second, since vitamin D is important to calcium homeostasis and metabolism, a deficiency of the vitamin results in rickets, or the adult form of the disease, osteomalacia. Rickets, because it happens in immature bones, leads to frequent fractures and skeletal deformities. Osteomalacia, because it occurs in adults with fully formed bones, usually only results in numerous fractures.
At this point, that’s it. Robust evidence only supports those two physiological effects.
Here are few claims made by the supplement-pushing crowd:
- Vitamin D prevents breast cancer – no evidence.
- Vitamin D prevents breast cancer – no evidence again.
- Vitamin D reduces blood pressure – no again.
- Vitamin D reduces risk of death – no evidence.
- Vitamin D improves cardiometabolic outcomes – systematic review says no.
- Vitamin D reduces risk of colorectal cancers – no evidence.
- Vitamin D improves skeletal, vascular or cancer outcomes – meta-analysis says no.
- Vitamin D improves mortality outcomes for elderly patients – a massive meta review says there is weak evidence, but that’s clouded by various reporting biases that make the data almost worthless.
But it doesn’t hurt you right?
That’s the appropriate question. All evidence-based medicine should weigh the evidence that a particular treatment has a benefit against any potential harm.
Right now, we know that vitamin D does two things – helps absorption of minerals and prevents calcium homeostasis which causes bone damage. Most people in developed countries get sufficient vitamin D from sunlight or foods.
And even if a person doesn’t, there are blood tests that can confirm a vitamin D deficiency, and an appropriate supplementation level should be prescribed. In other words, if an issue is discovered through a real diagnosis, then a careful plan can be implemented to prevent any consequences of low vitamin D.
But let’s say you refuse to accept my evidence that vitamin D is more or less useless, except for those very few who have low levels. You just believe in the charlatans who are pushing megadoses of vitamin D, even if you have not been diagnosed with a chronic deficiency. I would almost say, no harm, no foul.
Except for a small little issue. There is a lot of evidence that vitamin D supplementation not only has no benefit (except again in two physiological situations) but it might actually cause harm. Here are just some of the risk of vitamin D supplements:
- In a study of 409 elderly people in Finland showed that vitamin D supplementation failed to offer any benefits compared to placebo or exercise – and, in fact, the study suggested that fracture rates were slightly higher in the study population.
- Another study in Australia established that patients that had “optimal blood levels” of vitamin D had increased rates of fractures and falls compared to those on low doses or who failed to reach those blood levels.
- Excess maternal vitamin D during pregnancy may lead to hypercalcemia (excess blood calcium) which can increase fetal sensitivity to effects of vitamin D and lead to a syndrome of mental retardation and facial deformities.
- Excess vitamin D may include symptoms such as mental retardation in young children, abnormal bone growth and formation, diarrhea, irritability, weight loss, and severe depression.
And I barely touched the surface of the body of research that establishes the potential dangers of excess vitamin D. And unless you have had blood tests to determine the level of vitamin D in your blood, even a small supplement may push you over into the toxic range.
A review of the vitamin D review
Yes, vitamin D is necessary for human health. It is necessary for absorption of some minerals and maintaining proper calcium homeostasis, necessary for bone health.
In developed countries, vitamin D insufficiency is relatively rare. We either produce sufficient amounts of the vitamin while exposed to sunlight (not a really safe way to do it) or through a varied diet. But if one has a low level of vitamin D, it is very easy to diagnose and treat through a properly measured dose of the vitamin.
There is very little evidence that vitamin D supplementation has any effect on any other medical condition. It doesn’t prevent cancers or cardiovascular disease. It does not reduce your risk of death. It doesn’t do much of anything, except in the two, very narrow, physiological aspects.
And no, if a little vitamin D helps maintain some aspects of your health, a lot will not make it better. It might make it worse.
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